Successive objective long-case assessment as a driver of clerkship learning – evaluation through perception questionnaire

Dear Sir

Medical students during their clinical clerkship are expected to build competence in interrelated components of clinical, communication and problem-solving skills. However, it often involves rapid rotations through speciality wards in busy hospital environment, with lack of expectation of what is to be achieved at the end of clerkship. Assessment is introduced, often at the end of clerkship, as a measure of the learning achieved. This can make a rather unstructured and unproductive learning experience.

We believe successive objective clinical assessment may have a role in structuring and driving clerkship learning. Assessment increases students’ motivation and may have intrinsic ability to drive learning (Larsen et al. 2008). Provision of feedback can add formative value.

We implemented a two-weekly objective long-case clinical assessment, coupled with feedback, through a 6-week module of clinical clerkship in undergraduate medicine in our institution. Assessment format is adapted from Gleeson's Objective Structured Long Examination Record (OSLER) (Gleeson 1997). Assessors were encouraged to identify the student's strength and weaknesses and suggest strategies for improvement.

This approach was evaluated via questionnaire to participants with reference to their perceived educational impact, feasibility and acceptability. All 119 participating students and 17 out of 19 assessors completed the questionnaire.

Students agreed that patient spectrum was appropriate and fair, resulting in improved history taking and presentation skill (96.6%), clinical examination skills (89%) and clinical reasoning skills (90.7%). it was graded to have helped learning “tremendously” and “moderately” by 64.7% and 32.8% of students, respectively. Perceived improvement is attributable more to the successive nature of the assessment since only 63% of students were provided with feedback. 96.6% of students and 94.1% assessors perceived the format created a stressful but positive learning environment. 52.9% assessors agreed that it consumes significant resources but 88.2% rated it as manageable and support its continuation.

We have demonstrated that frequent intermittent in-course clinical assessment with emphasis on individual feedback is feasible, acceptable and has significant positive educational impact.

Toh Peng Yeow, Wai Sun Choo, Amir S. Khir, Li Cher Loh, Department of Medicine, Penang Medical College, 11450 Penang, Malaysia. E-mail: [email protected]